Combination therapy

ABSTRACT

The present invention relates to a method for the production of an antiangiogenic and/or vascular permeability reducing effect in a warm-blooded animal such as a human, which is optionally being treated with ionising radiation, particularly a method for the treatment of a cancer, particularly a cancer involving a solid tumour, which comprises one of: the administration of ZD6474 in combination with 5-FU; the administration of ZD6474 in combination with CPT-11; and the administration of ZD6474 in combination with 5-FU and CPT-11; to a pharmaceutical composition comprising one of: ZD6474 and 5-FU; ZD6474 and CPT-11; and ZD6474 and 5-FU and CPT-11; to a combination product comprising one of: ZD6474 and 5-FU; ZD6474 and CPT-11; and ZD6474 and 5-FU and CPT-11, for use in a method of treatment of a human or animal body by therapy; to a kit comprising one of: ZD6474 and 5-FU; ZD6474 and CPT-11; and ZD6474 and 5-FU and CPT-11; to the use of one of: ZD6474 and 5-FU; ZD6474 and CPT-11; and ZD6474 and 5-FU and CPT-11, in the manufacture of a medicament for use in the production of an antiangiogenic and/or vascular permeability reducing effect in a warm-blooded animal such as a human which is optionally being treated with ionising radiation.

The present invention relates to a method for the production of anantiangiogenic and/or vascular permeability reducing effect in awarm-blooded animal such as a human, which is optionally being treatedwith ionising radiation, particularly a method for the treatment of acancer, particularly a cancer involving a solid tumour, which comprisesone of: the administration of ZD6474 in combination with 5-FU; theadministration of ZD6474 in combination with CPT-11; and theadministration of ZD6474 in combination with 5-FU and CPT-11; to apharmaceutical composition comprising one of: ZD6474 and 5-FU; ZD6474and CPT-11; and ZD6474 and 5-FU and CPT-11; to a combination productcomprising one of: ZD6474 and 5-FU; ZD6474 and CPT-11; and ZD6474 and5-FU and CPT-11, for use in a method of treatment of a human or animalbody by therapy; to a kit comprising one of: ZD6474 and 5-FU; ZD6474 andCPT-11; and ZD6474 and 5-FU and CPT-11; to the use of one of: ZD6474 and5-FU; ZD6474 and CPT-11; and ZD6474 and 5-FU and CPT-11, in themanufacture of a medicament for use in the production of anantiangiogenic and/or vascular permeability reducing effect in awarm-blooded animal such as a human which is optionally being treatedwith ionising radiation.

Normal angiogenesis plays an important role in a variety of processesincluding embryonic development, wound healing and several components offemale reproductive function. Undesirable or pathological angiogenesishas been associated with disease states including diabetic retinopathy,psoriasis, cancer, rheumatoid arthritis, atheroma, Kaposi's sarcoma andhaemangioma (Fan et al, 1995, Trends Pharmacol. Sci 16: 57-66; Folkman,1995, Nature Medicine 1: 27-31). Alteration of vascular permeability isthought to play a role in both normal and pathological physiologicalprocesses (Cullinan-Bove et al, 1993, Endocrinology 133: 829-837; Sengeret al, 1993, Cancer and Metastasis Reviews, 12: 303-324). Severalpolypeptides with in vitro endothelial cell growth promoting activityhave been identified including, acidic and basic fibroblast growthfactors (aFGF & bFGF) and vascular endothelial growth factor (VEGF). Byvirtue of the restricted expression of its receptors, the growth factoractivity of VEGF, in contrast to that of the FGFs, is relativelyspecific towards endothelial cells. Recent evidence indicates that VEGFis an important stimulator of both normal and pathological angiogenesis(Jakeman et al 1993, Endocrinology, 133: 848-859; Kolch et al., 1995,Breast Cancer Research and Treatment, 36:139-155) and vascularpermeability (Connolly et al, 1989, J. Biol. Chem. 264: 20017-20024).Antagonism of VEGF action by sequestration of VEGF with antibody canresult in inhibition of tumour growth (Kim et al, 1993, Nature 362:841-844).

Receptor tyrosine kinases (RTKs) are important in the transmission ofbiochemical signals across the plasma membrane of cells. Thesetransmembrane molecules characteristically consist of an extracellularligand-binding domain connected through a segment in the plasma membraneto an intracellular tyrosine kinase domain. Binding of ligand to thereceptor results in stimulation of the receptor-associated tyrosinekinase activity which leads to phosphorylation of tyrosine residues onboth the receptor and other intracellular molecules. These changes intyrosine phosphorylation initiate a signalling cascade leading to avariety of cellular responses. To date, at least nineteen distinct RTKsubfamilies, defined by amino acid sequence homology, have beenidentified. One of these subfamilies is presently comprised by thefms-like tyrosine kinase receptor, Flt-1, the kinase insertdomain-containing receptor, KDR (also referred to as Flk-1), and anotherfms-like tyrosine kinase receptor, Flt-4. Two of these related RTKs,Flt-1 and KDR, have been shown to bind VEGF with high affinity (De Vrieset al, 1992, Science 255: 989-991; Terman et al, 1992, Biochem Biophys.Res. Comm. 1992, 187: 1579-1586). Binding of VEGF to these receptorsexpressed in heterologous cells has been associated with changes in thetyrosine phosphorylation status of cellular proteins and calcium fluxes.

VEGF is a key stimulus for vasculogenesis and angiogenesis. Thiscytokine induces a vascular sprouting phenotype by inducing endothelialcell proliferation, protease expression and migration, and subsequentorganisation of cells to form a capillary tube (Keck, P. J., Hauser, S.D., Krivi, G., Sanzo, K., Warren, T., Feder, J., and Connolly, D. T.,Science (Washington D.C.), 246: 1309-1312, 1989; Lamoreaux, W. J.,Fitzgerald, M. J., Reiner, A., Hasty, K. A., and Charles, S. T.,Microvasc. Res., 55: 29-42, 1998; Pepper, M. S., Montesano, R.,Mandroita, S. J., Orci, L. and Vassalli, J. D., Enzyme Protein, 49:138-162, 1996.). In addition, VEGF induces significant vascularpermeability (Dvorak, H. F., Detmar, M., Claffey, K. P., Nagy, J. A.,van de Water, L., and Senger, D. R., (Int. Arch. Allergy Immunol., 107:233-235, 1995; Bates, D. O., Heald, R. I., Curry, F. E. and Williams, B.J. Physiol. (Lond.), 533: 263-272, 2001), promoting formation of ahyper-permeable, immature vascular network which is characteristic ofpathological angiogenesis.

It has been shown that activation of KDR alone is sufficient to promoteall of the major phenottypic responses to VEGF, including endothelialcell proliferation, migration, and survival, and the induction ofvascular permeability (Meyer, M., Clauss, M., Lepple-Wienhues, A,Waltenberger, J., Augustin, H. G., Ziche, M., Lanz, C., Büttner, M.,Rziha, H-J., and Dehio, C., EMBO J., 18: 363-374, 1999; Zeng, H.,Sanyal, S. and Mukhopadhyay, D., J. Biol. Chem., 276: 32714-32719, 2001;Gille, H., Kowalski, J., Li B., LeCouter, J., Moffat, B, Zioncheck, T.F., Pelletier, N. and Ferrara, N., J. Biol. Chem., 276: 3222-3230,2001).

Quinazoline derivatives which are inhibitors of VEGF receptor tyrosinekinase are described in International Patent Application PublicationNos. WO 98/13354 and WO 01/32651. In WO 98/13354 and WO 01/32651compounds are described which possess activity against VEGF receptortyrosine kinase whilst possessing some activity against EGF receptortyrosine kinase. The compound of the present invention, ZD6474, fallswithin the broad general disclosure of WO 98/13354 and is exemplified inWO 01/32651.

In WO 01/32651 it is stated that compounds of that invention:

“may be applied as a sole therapy or may involve, in addition to acompound of the invention, one or more other substances and/ortreatments. Such conjoint treatment may be achieved by way of thesimultaneous, sequential or separate administration of the individualcomponents of the treatment.” WO 01/32651 then goes on to describeexamples of such conjoint treatment including surgery, radiotherapy andmany types of chemotherapeutic agent including 5-fluorouracil (5-FU) andirinotecan (CPT-11). Nowhere in WO 01/32651 does it state that use ofany compound of the invention therein with other treatments will producesurprisingly beneficial effects.

Unexpectedly and surprisingly we have now found that the particularcompound ZD6474 used in combination with a particular selection ofcombination therapies, namely with one of: 5-FU; CPT-11; and 5-FU andCPT-11, produces significantly better antiangiogenic and/or vascularpermeability reducing effects than any one of: ZD6474; 5-FU; CPT-11; and5-FU and CPT-11 used alone. According to one aspect of the presentinvention, ZD6474 used in combination with one of: 5-FU; CPT-11; and5-FU and CPT-11 produces significantly better anti-cancer effects thanany one of: ZD6474; 5-FU; CPT-11; and 5-FU and CPT-11 used alone.According to one aspect of the present invention, ZD6474 used incombination with one of: 5-FU; CPT-11; and 5-FU and CPT-11 producessignificantly better effects on solid tumours than any one of: ZD6474;5-FU; CPT-1; and 5-FU and CPT-11 used alone. According to one aspect ofthe present invention, ZD6474 used in combination with one of: 5-FU;CPT-11; and 5-FU and CPT-11 produces significantly better effects incolorectal cancer than any one of: ZD6474; 5-FU; CPT-11; and 5-FU andCPT-11 used alone.

Anti-cancer effects of a method of treatment of the present inventioninclude, but are not limited to, anti-tumour effects, the response rate,the time to disease progression and the survival rate. Anti-tumoureffects of a method of treatment of the present invention include, butare not limited to, inhibition of tumour growth, tumour growth delay,regression of tumour, shrinkage of tumour, increased time to regrowth oftumour on cessation of treatment, slowing of disease progression. It isexpected that when a method of treatment of the present invention isadministered to a warm-blooded animal such as a human, in need oftreatment for cancer, with or without a solid tumour, said method oftreatment will produce an effect, as measured by, for example, one ormore of: the extent of the anti-tumour effect, the response rate, thetime to disease progression and the survival rate.

According to the present invention there is provided a method for theproduction of an antiangiogenic and/or vascular permeability reducingeffect in a warm-blooded animal such as a human, which comprisesadministering to said animal an effective amount of,4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazoline,also known as ZD6474:

or a pharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of one of:

a) 5-FU;

b) CPT-11; and

c) 5-FU and CPT-11.

According to a further aspect of the present invention there is provideda method for the treatment of a cancer in a warm-blooded animal such asa human, which comprises administering to said animal an effectiveamount of ZD6474 or a pharmaceutically acceptable salt thereof, before,after or simultaneously with an effective amount of one of: 5-FU;CPT-11; and 5-FU and CPT-11.

According to a further aspect of the present invention there is provideda method for the treatment of a cancer involving a solid tumour in awarm-blooded animal such as a human, which comprises administering tosaid animal an effective amount of ZD6474 or a pharmaceuticallyacceptable salt thereof, before, after or siumultaneously with aneffective amount of one of: 5-FU; CPT-11; and 5-FU and CPT-11.

According to a further aspect of the present invention there is provideda method for the treatment of colorectal cancer in a warm-blooded animalsuch as a human, which comprises administering to said animal aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, before, after or simultaneously with an effective amount of oneof: 5-FU; CPT-11; and 5-FU and CPT-11.

According to a further aspect of the present invention there is provideda method for the production of an antiangiogenic and/or vascularpermeability reducing effect in a warm-blooded animal such as a human,which comprises administering to said animal an effective amount ofZD6474 or a pharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of one of: 5-FU; CPT-11; and5-FU and CPT-11; wherein ZD6474, 5-FU and CPT-11 may each optionally beadministered together with a pharmaceutically acceptable excipient orcarrier.

According to a further aspect of the present invention there is provideda method for the treatment of a cancer in a warm-blooded animal such asa human, which comprises administering to said animal an effectiveamount of ZD6474 or a pharmaceutically acceptable salt thereof, before,after or simultaneously with an effective amount of one of: 5-FU;CPT-11; and 5-FU and CPT-11; wherein ZD6474, 5-FU and CPT-11 may eachoptionally be administered together with a pharmaceutically acceptableexcipient or carrier.

According to a further aspect of the present invention there is provideda method for the treatment of a cancer involving a solid tumour in awarm-blooded animal such as a human, which comprises administering tosaid animal an effective amount of ZD6474 or a pharmaceuticallyacceptable salt thereof, before, after or simultaneously with aneffective amount of one of: 5-FU; CPT-11; and 5-Fu and CPT-11; whereinZD6474, 5-FU and CPT-11 may each optionally be administered togetherwith a pharmaceutically acceptable excipient or carrier.

According to a further aspect of the present invention there is provideda method for the treatment of colorectal cancer in a warm-blooded animalsuch as a human, which comprises administering to said animal aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, before, after or simultaneously with an effective amount of oneof: 5-FU; CPT-11; and 5-FU and CPT-11; wherein ZD6474, 5-Fu and CPT-11may each optionally be administered together with a pharmaceuticallyacceptable excipient or carrier.

According to a further aspect of the invention there is provided apharmaceutical composition which comprises ZD6474 or a pharmaceuticallyacceptable salt thereof, and 5-FU in association with a pharmaceuticallyacceptable excipient or carrier.

According to a further aspect of the invention there is provided apharmaceutical composition which comprises ZD6474 or a pharmaceuticallyacceptable salt thereof, and CPT-11 in association with apharmaceutically acceptable excipient or carrier.

According to a further aspect of the invention there is provided apharmaceutical composition which comprises ZD6474 or a pharmaceuticallyacceptable salt thereof, and 5-FU and CPT-11 in association with apharmaceutically acceptable excipient or carrier.

According to a further aspect of the present invention there is provideda combination product comprising ZD6474 or a pharmaceutically acceptablesalt thereof and 5-FU, for use in a method of treatment of a human oranimal body by therapy.

According to a further aspect of the present invention there is provideda combination product comprising ZD6474 or a pharmaceutically acceptablesalt thereof and CPT-11, for use in a method of treatment of a human oranimal body by therapy.

According to a further aspect of the present invention there is provideda combination product comprising ZD6474 or a pharmaceutically acceptablesalt thereof and 5-FU and CPT-11, for use in a method of treatment of ahuman or animal body by therapy.

According to a further aspect of the present invention there is provideda kit comprising ZD6474 or a pharmaceutically acceptable salt thereof,and 5-FU.

According to a further aspect of the present invention there is provideda kit comprising ZD6474 or a pharmaceutically acceptable salt thereof,and CPT-11.

According to a further aspect of the present invention there is provideda kit comprising ZD6474 or a pharmaceutically acceptable salt thereof,and 5-FU and CPT-11.

According to a further aspect of the present invention there is provideda kit comprising:

a) ZD6474 or a pharmaceutically acceptable salt thereof in a first unitdosage form;

b) 5-FU in a second unit dosage form; and

c) container means for containing said first and second dosage forms.

According to a further aspect of the present invention there is provideda kit comprising:

a) ZD6474 or a pharmaceutically acceptable salt thereof in a first unitdosage form;

b) CPT-11 in a second unit dosage form; and

c) container means for containing said first and second dosage forms.

According to a further aspect of the present invention there is provideda kit comprising:

a) ZD6474 or a pharmaceutically acceptable salt thereof in a first unitdosage form;

b) 5-FU in a second unit dosage form;

c) CPT-11 in a third unit dosage form; and

d) container means for containing said first, second and third dosageforms.

According to a further aspect of the present invention there is provideda kit comprising:

a) ZD6474 or a pharmaceutically acceptable salt thereof, together with apharmaceutically acceptable excipient or carrier, in a first unit dosageform;

b) 5-FU together with a pharmaceutically acceptable excipient orcarrier, in a second unit dosage form; and

c) container means for containing said first and second dosage forms.

According to a further aspect of the present invention there is provideda kit comprising:

a) ZD6474 or a pharmaceutically acceptable salt thereof, together with apharmaceutically acceptable excipient or carrier, in a first unit dosageform;

b) CPT-11 together with a pharmaceutically acceptable excipient orcarrier, in a second unit dosage form; and

c) container means for containing said first and second dosage forms.

According to a further aspect of the present invention there is provideda kit comprising:

a) ZD6474 or a pharmaceutically acceptable salt thereof, together with apharmaceutically acceptable excipient or carrier, in a first unit dosageform;

b) 5-FU together with a pharmaceutically acceptable excipient orcarrier, in a second unit dosage form;

c) CPT-11 together with a pharmaceutically acceptable excipient orcarrier, in a third unit dosage form; and

d) container means for containing said first, second and third dosageforms.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof and oneof:

a) 5-FU;

b) CPT-11; and

c) 5-FU and CPT-11

in the manufacture of a medicament for use in the production of anantiangiogenic and/or vascular permeability reducing effect in awarm-blooded animal such as a human.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof and oneof:

a) 5-FU;

b) CPT-11; and

c) 5-FU and CPT-11

in the manufacture of a medicament for use in the production of ananti-cancer effect in a warm-blooded animal such as a human.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof and oneof:

4) 5-FU;

b) CPT-11; and

c) 5-FLU and CPT-11

in the manufacture of a medicament for use in the production of ananti-tumour effect in a warm-blooded animal such as a human.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof and oneof:

a) 5-FU;

b) CPT-11; and

c) 5-FU and CPT-11

in the manufacture of a medicament for use in the production of ananti-cancer effect in a warm-blooded animal such as a human wherein thecancer is a colorectal cancer.

According to a further aspect of the present invention there is provideda therapeutic combination treatment comprising the administration of aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, optionally together with a pharmaceutically acceptableexcipient or carrier, and the administration of an effective amount of5-FU, optionally together with a pharmaceutically acceptable excipientor carrier, to a warm-blooded animal such as a human in need of suchtherapeutic treatment wherein the ZD6474 and 5-FU may be administeredsimultaneously, sequentially or separately and in any order.

According to a further aspect of the present invention there is provideda therapeutic combination treatment comprising the administration of aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, optionally together with a pharmaceutically acceptableexcipient or carrier, and the administration of an effective amount ofCPT-11, optionally together with a pharmaceutically acceptable excipientor carrier, to a warm-blooded animal such as a human in need of suchtherapeutic treatment wherein the ZD6474 and CPT-11 may be administeredsimultaneously, sequentially or separately and in any order.

According to a further aspect of the present invention there is provideda therapeutic combination treatment comprising the administration of aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, optionally together with a pharmaceutically acceptableexcipient or carrier, and the administration of an effective amount of5-FU, optionally together with a pharmaceutically acceptable excipientor carrier, and the administration of an effective amount of CPT-11,optionally together with a pharmaceutically acceptable excipient orcarrier, to a warm-blooded animal such as a human in need of suchtherapeutic treatment wherein the ZD6474, 5-FU and CPT-11 may beadministered simultaneously, sequentially or separately and in anyorder.

A combination treatment of the present invention as defined herein maybe achieved by way of the simultaneous, sequential or separateadministration of the individual components of said treatment. Acombination treatment as defined herein may be applied as a sole therapyor may involve surgery or radiotherapy or an additional chemotherapeuticagent in addition to a combination treatment of the invention. Surgerymay comprise the step of partial or complete tumour resection, prior to,during or after the administration of the combination treatment withZD6474 described herein

Other chemotherapeutic agents for optional use with a combinationtreatment of the present invention include those described in WO01/32651 which is incorporated herein by reference. Such chemotherapymay cover five main categories of therapeutic agent as stated in WO01/32651:

(i) other antiangiogenic agents including vascular targeting agents;

(ii) cytostatic agents;

(ii) biological response modifiers (for example interferon);

(iv) antibodies (for example edrecolomab); and

(v) antiproliferative/antineoplastic drugs and combinations thereof, asused in medical oncology; and other categories of agent are:

(vi) antisense therapies;

(vii) gene therapy approaches; and

(ix) immunotherapy approaches.

The administration of a multiple combination of ZD6474, 5-FU andionising radiation or ZD6474, CPT-11 and ionising radiation or ZD6474,5-FU, CPT-11 and ionising radiation may produce effects, such asanti-tumour effects, greater than those achieved with any of ZD6474,5-FU, CPT-11 and ionising radiation used alone. The administration of amultiple combination of ZD6474, 5-FU and ionising radiation or ZD6474,CPT-11 and ionising radiation or ZD6474, 5-FU, CPT-11 and ionisingradiation may produce effects, such as anti-tumour effects, greater thanthose achieved with the combination of ZD6474 and 5-FU, greater thanthose achieved with the combination of ZD6474 and CPT-11 and greaterthan those achieved with the combination of ZD6474, 5-FU and CPT-11. Theadministration of a multiple combination of ZD6474, 5-FU and ionisingradiation or ZD6474, CPT-11 and ionising radiation or ZD6474, 5-FU,CPT-11 and ionising radiation may produce effects, such as anti-tumoureffects, greater than those achieved with the combination of ZD6474 andionising radiation, greater than those achieved with the combination of5-FU and ionising radiation, greater than those achieved with thecombination of CPT-11 and ionising radiation, and greater than thoseachieved with the combination of 5-FU, CPT-11 and ionising radiation.

According to the present invention there is provided a method for theproduction of an antiangiogenic and/or vascular permeability reducingeffect in a warm-blooded animal such as a human, which comprisesadministering to said animal an effective amount of ZD6474 or apharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of 5-FU and before, after orsimultaneously with an effective amount of ionising radiation.

According to the present invention there is provided a method for theproduction of an antiangiogenic and/or vascular permeability reducingeffect in a warm-blooded animal such as a human, which comprisesadministering to said animal an effective amount of ZD6474 or apharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of CPT-11 and before, after orsimultaneously with an effective amount of ionising radiation.

According to the present invention there is provided a method for theproduction of an antiangiogenic and/or vascular permeability reducingeffect in a warm-blooded animal such as a human, which comprisesadministering to said animal an effective amount of ZD6474 or apharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of 5-FU, before, after orsimultaneously with an effective amount of CPT-11 and before, after orsimultaneously with an effective amount of ionising radiation.

According to the present invention there is provided a method for thetreatment of a cancer in a warm-blooded animal such as a human, whichcomprises administering to said animal an effective amount of ZD6474 ora pharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of 5-FU and before, after orsimultaneously with an effective amount of ionising radiation.

According to the present invention there is provided a method for thetreatment of a cancer in a warm-blooded animal such as a human, whichcomprises administering to said animal an effective amount of ZD6474 ora pharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of CPT-11 and before, after orsimultaneously with an effective amount of ionising radiation.

According to the present invention there is provided a method for thetreatment of a cancer in a warm-blooded animal such as a human, whichcomprises administering to said animal an effective amount of ZD6474 ora pharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of 5-FU, before, after orsimultaneously with an effective amount of CPT-11 and before, after orsimultaneously with an effective amount of ionising radiation.

According to the present invention there is provided a method for thetreatment of a cancer involving a solid tumour in a warm-blooded animalsuch as a human, which comprises administering to said animal aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, before, after or simultaneously with an effective amount of5-FU and before, after or simultaneously with an effective amount ofionising radiation.

According to the present invention there is provided a method for thetreatment of a cancer involving a solid tumour in a warm-blooded animalsuch as a human, which comprises administering to said animal aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, before, after or simultaneously with an effective amount ofCPT-11 and before, after or simultaneously with an effective amount ofionising radiation.

According to the present invention there is provided a method for thetreatment of a cancer involving a solid tumour in a warm-blooded animalsuch as a human, which comprises administering to said animal aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, before, after or simultaneously with an effective amount of5-FU, before, after or simultaneously with an effective amount of CPT-11and before, after or simultaneously with an effective amount of ionisingradiation.

In particular the cancer involving a solid tumour is colorectal cancer.

According to a further aspect of the present invention there is provideda method for the production of an antiangiogenic and/or vascularpermeability reducing effect in a warm-blooded animal such as a human,which comprises administering to said animal an effective amount ofZD6474 or a pharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of 5-FU and before, after orsimultaneously with an effective amount of ionising radiation, whereinZD6474 and 5-FU may each optionally be administered together with apharmaceutically acceptable excipient or carrier.

According to a further aspect of the present invention there is provideda method for the production of an antiangiogenic and/or vascularpermeability reducing effect in a warm-blooded animal such as a human,which comprises administering to said animal an effective amount ofZD6474 or a pharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of CPT-11 and before, after orsimultaneously with an effective amount of ionising radiation, whereinZD6474 and CPT-11 may each optionally be administered together with apharmaceutically acceptable excipient or carrier.

According to a further aspect of the present invention there is provideda method for the production of an antiangiogenic and/or vascularpermeability reducing effect in a warm-blooded animal such as a human,which comprises administering to said animal an effective amount ofZD6474 or a pharmaceutically acceptable salt thereof, before, after orsimultaneously with an effective amount of 5-FU, before, after orsimultaneously with an effective amount of CPT-11 and before, after orsimultaneously with an effective amount of ionising radiation, whereinZD6474, 5-FU and CPT-11 may each optionally be administered togetherwith a pharmaceutically acceptable excipient or carrier.

According to a further aspect of the present invention there is provideda method for the treatment of a cancer in a warm-blooded anal such as ahuman, which comprises administering to said animal an effective amountof ZD6474 or a pharmaceutically acceptable salt thereof, before, afteror simultaneously with an effective amount of 5-FU and before, after orsimultaneously with an effective amount of ionising radiation, whereinZD6474 and 5-FU may each optionally be administered together with apharmaceutically acceptable excipient or carrier.

According to a further aspect of the present invention there is provideda method for the treatment of a cancer in a warm-blooded animal such asa human, which comprises administering to said animal an effectiveamount of ZD6474 or a pharmaceutically acceptable salt thereof, before,after or simultaneously with an effective amount of CPT-11 and before,after or simultaneously with an effective amount of ionising radiation,wherein ZD6474 and CPT-11 may each optionally be administered togetherwith a pharmaceutically acceptable excipient or carrier.

According to a further aspect of the present invention there is provideda method for the treatment of a cancer in a warm-blooded animal such asa human, which comprises administering to said animal an effectiveamount of ZD6474 or a pharmaceutically acceptable salt thereof, before,after or simultaneously with an effective amount of 5-FU, before, afteror simultaneously with an effective amount of CPT-11 and before, afteror simultaneously with an effective amount of ionising radiation,wherein ZD6474, 5-FU and CPT-11 may each optionally be administeredtogether with a pharmaceutically acceptable excipient or carrier.

According to a further aspect of the present invention there is provideda method for the treatment of a cancer involving a solid tumour in awarm-blooded animal such as a human, which comprises administering tosaid animal an effective amount of ZD6474 or a pharmaceuticallyacceptable salt thereof, before, after or simultaneously with aneffective amount of 5-FU and before, after or simultaneously with aneffective amount of ionising radiation, wherein ZD6474 and 5-FU may eachoptionally be administered together with a pharmaceutically acceptableexcipient or carrier.

According to a further aspect of the present invention there is provideda method for the treatment of a cancer involving a solid tumour in awarm-blooded animal such as a human, which comprises administering tosaid animal an effective amount of ZD6474 or a pharmaceuticallyacceptable salt thereof, before, after or simultaneously with aneffective amount of CPT-11 and before, after or simultaneously with aneffective amount of ionising radiation, wherein ZD6474 and CPT-11 mayeach optionally be administered together with a pharmaceuticallyacceptable excipient or carrier.

According to a further aspect of the present invention there is provideda method for the treatment of a cancer involving a solid tumour in awarm-blooded animal such as a human, which comprises administering tosaid animal an effective amount of ZD6474 or a pharmaceuticallyacceptable salt thereof, before, after or simultaneously with aneffective amount of 5-FU, before, after or simultaneously with aneffective amount of CPT-11 and before, after or simultaneously with aneffective amount of ionising radiation, wherein ZD6474, 5-FU and CPT-11may each optionally be administered together with a pharmaceuticallyacceptable excipient or carrier.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof and 5-FUin the manufacture of a medicament for use in the production of anantiangiogenic and/or vascular permeability reducing effect in awarm-blooded animal such as a human which is being treated with ionisingradiation.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof andCPT-11 in the manufacture of a medicament for use in the production ofan antiangiogenic and/or vascular permeability reducing effect in awarm-blooded animal such as a human which is being treated with ionisingradiation.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof and 5-FUand CPT-11 in the manufacture of a medicament for use in the productionof an antiangiogenic and/or vascular permeability reducing effect in awarm-blooded animal such as a human which is being treated with ionisingradiation.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof and 5-FUin the manufacture of a medicament for use in the production of ananti-cancer effect in a warm-blooded animal such as a human which isbeing treated with ionising radiation

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof andCPT-11 in the manufacture of a medicament for use in the production ofan anti-cancer effect in a warm-blooded animal such as a human which isbeing treated with ionising radiation.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof and 5-FUand CPT-11 in the manufacture of a medicament for use in the productionof an anti-cancer effect in a warm-blooded animal such as a human whichis being treated with ionising radiation.

In particular the warm-blooded animal such as a human has colorectalcancer.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof and 5-FUin the manufacture of a medicament for use in the production of ananti-tumour effect in a warm-blooded animal such as a human which isbeing treated with ionising radiation.

According to a farther aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof andCPT-11 in the manufacture of a medicament for use in the production ofan anti-tumour effect in a warm-blooded animal such as a human which isbeing treated with ionising radiation.

According to a further aspect of the present invention there is providedthe use of ZD6474 or a pharmaceutically acceptable salt thereof and 5-FUand CPT-11 in the manufacture of a medicament for use in the productionof an anti-tumour effect in a warm-blooded animal such as a human whichis being treated with ionising radiation.

According to a further aspect of the present invention there is provideda therapeutic combination treatment comprising the administration of aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, optionally together with a pharmaceutically acceptableexcipient or carrier, and the administration of an effective amount of5-FU, optionally together with a pharmaceutically acceptable excipientor carrier and the administration of an effective amount of ionisingradiation, to a warm-blooded animal such as a human in need of suchtherapeutic treatment wherein the ZD6474, 5-FU and ionising radiationmay be administered simultaneously, sequentially or separately and inany order.

According to a further aspect of the present invention there is provideda therapeutic combination treatment comprising the administration of aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, optionally together with a pharmaceutically acceptableexcipient or carrier, and the administration of an effective amount ofCPT-11, optionally together with a pharmaceutically acceptable excipientor carrier and the administration of an effective amount of ionisingradiation, to a warm-blooded animal such as a human in need of suchtherapeutic treatment wherein the ZD6474, CPT-11 and ionising radiationmay be administered simultaneously, sequentially or separately and inany order.

According to a further aspect of the present invention there is provideda therapeutic combination treatment comprising the administration of aneffective amount of ZD6474 or a pharmaceutically acceptable saltthereof, optionally together with a pharmaceutically acceptableexcipient or carrier, and the administration of an effective amount of5-FU, optionally together with a pharmaceutically acceptable excipientor carrier, and the administration of an effective amount of CPT-11,optionally together with a pharmaceutically acceptable excipient orcarrier, and the administration of an effective amount of ionisingradiation, to a warm-blooded animal such as a human in need of suchtherapeutic treatment wherein the ZD6474, 5-FU, CPT-11 and ionisingradiation may be administered simultaneously, sequentially or separatelyand in any order.

A warm-blooded animal such as a human which is being treated withionising radiation means a warm-blooded animal such as a human which istreated with ionising radiation before, after or at the same time as theadministration of a medicament or combination treatment comprisingZD6474 and one of: 5-FU; CPT-11; and 5-FU and CPT-11. For example saidionising radiation may be given to said warm-blooded animal such as ahuman within the period of a week before to a week after theadministration of a medicament or combination treatment comprisingZD6474 and one of: 5-FU; CPT-11; and 5-FU and CPT-11. This means thatZD6474, 5-FU, CPT-11 and ionising radiation may be administeredseparately or sequentially in any order, or may be administeredsimultaneously. The warm-blooded animal may experience the effect ofeach of ZD6474, 5-FU, CPT-11 and radiation simultaneously.

According to one aspect of the present invention the ionising radiationis administered before one of ZD6474 and one of: 5-FU; CPT-1; and 5-FUand CPT-11, or after one of ZD6474 and one of: 5-FU; CPT-11; and 5-FUand CPT-11.

According to one aspect of the present invention the ionising radiationis administered before any of ZD6474 and one of: 5-FU; CPT-11; and 5-FUand CPT-11 or after all of ZD6474 and one of: 5-FU; CPT-1; and 5-FU andCPT-11.

According to one aspect of the present invention ZD6474 is administeredto a warm-blooded anima after the animal has been treated with ionisingradiation.

As stated above the combination treatments of the present invention,that is ZD6474, optionally with ionising radiation, combined with oneof: 5-FU; CPT-11; and 5-FU and CPT-11, as defined herein, are ofinterest for their antiangiogenic and/or vascular permeability effects.Angiogenesis and/or increased vascular permeability is present in a widerange of disease states including cancer (including leukaemia, multiplemyeloma and lymphoma), diabetes, psoriasis, rheumatoid arthritis,Kaposi's sarcoma, haemangioma, acute and chronic nephropathies,atheroma, arterial restenosis, autoimmune diseases, acute inflammation,lymphoedema, excessive scar formation and adhesions, endometriosis,dysfunctional uterine bleeding and ocular diseases with retinal vesselproliferation (including age-related macular degeneration). Combinationtreatments of the present invention are expected to be particularlyuseful in the prophylaxis and treatment of diseases such as cancer andKaposi's sarcoma. In particular combination treatments of the inventionare expected to slow advantageously the growth of primary and recurrentsolid tumours of, for example, the colon, breast, prostate, lungs andskin. More particularly such combination treatments of the invention areexpected to inhibit any form of cancer associated with VEGF includingleukaemia, mulitple myeloma and lymphoma and also, for example, toinhibit the growth of those primary and recurrent solid tumours whichare associated with VEGF, especially those tumours which aresignificantly dependent on VEGF for their growth and spread, includingfor example, certain tumours of the colon, breast, prostate, lung, vulvaand skin.

According to one aspect of the present invention such combinationtreatments of the invention are expected to slow advantageously thegrowth of primary and secondary (recurrent) tumours in colorectalcancer.

In another aspect of the present invention ZD6474, optionally withionising radiation, and one of: 5-FU; CPT-11; and 5-FU and CPT-11 areexpected to inhibit the growth of those primary and recurrent solidtumours which are associated with VEGF especially those tumours whichare significantly dependent on VEGF for their growth and spread.

In another aspect of the present invention ZD6474, optionally withionising radiation, and one of: 5-FU; CPT-11; and 5-FU and CPT-11 areexpected to inhibit the growth of those primary and recurrent solidtumours which are associated with both VEGF and EGF especially thosetumours which are significantly dependent on VEGF and EGF for theirgrowth and spread.

According to another aspect of the present invention the effect of amethod of treatment of the present invention is expected to be at leastequivalent to the addition of the effects of each of the components ofsaid treatment used alone, that is, of each of ZD6474, 5-FU, CPT-11 andionising radiation used alone.

According to another aspect of the present invention the effect of amethod of treatment of the present invention is expected to be greaterthan the addition of the effects of each of the components of saidtreatment used alone, that is, of each of ZD6474, 5-FU, CPT-11 andionising radiation used alone.

According to another aspect of the present invention the effect of amethod of treatment of the present invention is expected to be asynergistic effect.

According to the present invention a combination treatment is defined asaffording a synergistic effect if the effect is therapeuticallysuperior, as measured by, for example, the extent of the response, theresponse rate, the time to disease progression or the survival period,to that achievable on dosing one or other of the components of thecombination treatment at its conventional dose. For example, the effectof the combination treatment is synergistic if the effect istherapeutically superior to the effect achievable with ZD6474, 5-FU,CPT-11, 5-FU and CPT-11, or ionising radiation used alone. Further, theeffect of the combination treatment is synergistic if a beneficialeffect is obtained in a group of patients that does not respond (orresponds poorly) to ZD6474, 5-FU, CPT-11, 5-FU and CPT-11, or ionisingradiation used alone. In addition, the effect of the combinationtreatment is defined as affording a synergistic effect if one of thecomponents is dosed at its conventional dose and the other component(s)is/are dosed at a reduced dose and the therapeutic effect, as measuredby, for example, the extent of the response, the response rate, the timeto disease progression or the survival period, is equivalent to thatachievable on dosing conventional amounts of the components of thecombination treatment. In particular, synergy is deemed to be present ifthe conventional dose of ZD6474, 5-FU, CPT-11, 5-FU and CPT-11, orionising radiation may be reduced without detriment to one Or more ofthe extent of the response, the response rate, the time to diseaseprogression and survival data, in particular without detriment to theduration of the response, but with fewer and/or less troublesomeside-effects than those that occur when conventional doses of eachcomponent are used.

The compositions described herein may be in a form suitable for oraladministration, for example as a tablet or capsule, for nasaladministration or administration by inhalation, for example as a powderor solution, for parenteral injection (including intravenous,subcutaneous, intramuscular, intravascular or infusion) for example as asterile solution, suspension or emulsion, for topical administration forexample as an ointment or cream for rectal administration for example asa suppository or the route of administration may be by direct injectioninto the tumour or by regional delivery or by local delivery. In otherembodiments of the present invention the ZD6474 of the combinationtreatment may be delivered endoscopically, intratracheally,intralesionally, percutaneously, intravenously, subcutaneously,intraperitoneally or intratumourally. In general the compositionsdescribed herein may be prepared in a conventional manner usingconventional excipients. The compositions of the present invention areadvantageously presented in unit dosage form.

ZD6474 will normally be administered to a warm-blooded animal at a unitdose within the range 10-500 mg per square metre body area of the animalfor example approximately 0.3-15 mg/kg in a human. A unit dose in therange, for example, 0.3-15 mg/kg, preferably 0.5-5 mg/kg is envisagedand this is normally a therapeutically-effective dose. A unit dosageform such as a tablet or capsule will usually contain, for example25-500 mg of active ingredient. Preferably a daily dose in the range of0.5-5 mg/kg is employed.

CPT-11 is also known as irinotecan. CPT-11 may be administered inaccordance with any known route of administration and dosage.

For example CPT-11 may be dosed at 350 mg/m² as an intravenous infusionover a 30 to 90 minute period every 3 weeks.

CPT-11 is a semi-synthetic derivative of camptothecin and is metabolisedin vivo to an active metabolite SN-38.

5-FU is 5-fluorouracil 5-FU may be administered according to any knownroute of administration and dosage.

For example 5-FU may be given as an intravenous daily infusion of 15mg/kg diluted in 500 ml of 5% dextrose solution or 500 ml 0.9% sodiumchloride solution given by intravenous infusion: at the rate of 40 dropsper minute over 4 hours; or infused over 30 to 60 minutes; or as a dailycontinuous infusion over 24 hours. The daily dose of 5-FU is recommendednot to exceed 1 g. 5-FU is usually given daily in one of these waysuntil 12-15 g has been given and this constitutes one course of 5-FU. Itis usual practice to leave 4 to 6 weeks between courses of 5-FU.Alternatively 5-FU may be dosed by intravenous injection at a dose of 12mg/kg on three consecutive days, followed by 6 mg/kg on days 5, 7 and 9ie on the three following alternate days, followed by a maintenance doseof 5-15 mg/kg by intravenous injection once a week. Alternatively 5-FUmay be given by intravenous injection at a dose of 15 mg/kg once a weekfor the duration of the patient's treatment. 5-FU may also be dosedintra-arterially as a regional perfusion at 5-7.5 mg/kg by 24 hourcontinuous infusion. 5-FU may also be dosed orally at a dose of 15 mg/kgonce a week or at a dose of 15 mg/kg for six successive days followed by15 mg/kg once a week.

5-FU is commonly administered with leucovorin. For the avoidance ofdoubt the combination treatments of the present invention include theuse of 5-FU when given with, or without, leucovorin.

Leucovorin may be administered according to any known route ofadministration and dosage. For example leucovorin may be administeredorally. When used in combination with 5-FU, leucovorin is convenientlyadministered as calcium leucovorin and given intravenously. For example,calcium leucovorin may be given at a dose of 200 mg/m² by slowintravenous injection, followed immediately by 5-FU at an initial doseof 370 mg/m² by intravenous injection. The injection of leucovorinshould not be given more rapidly than over 3-5 minutes because of thecalcium content of the solution This treatment is repeated daily for 5consecutive days. Subsequent courses may be given after a treatment-freeinterval of 21-28 days.

Alternatively the following regimen may be used: leucovorin 500 mg/m²given by 2 hour infusion every week for 6 weeks with 5-FU 500 mg/m²given as an iv bolus midway through the 6-week period.

Alternatively the following regimen may be used: leucovorin 200 mg/2given by iv 2 hour infusion followed by 5-FU 400 mg/m² iv bolus followedby 5-FU 600 mg/m² given by iv 22 hour infusion, repeated for 2consecutive days. The cycle is repeated every 2 weeks.

Alternatively 5-FU may be administered orally as capecitabine (Xeloda™),tegafur, or TS-1. Capecitabine is a relatively non-cytotoxicfluoropyrimidine carbamate which functions as an orally administeredprecursor of 5-FU. Capecitabine may be administered according to anyknown dosage. For example a dose of 1250 mg/m² may be given orally twicea day, (equivalent to a daily dose of 2500 mg/m²), for 14 days followedby a rest period of 7 days.

Combination treatments of the present invention include the use of 5-FUwhen given in any form, (including prodrug and precursor forms that areconverted to 5-FU systemically or within the tumour), when administeredvia any route and when given with, or without, leucovorin.

Combination treatments of the present invention include the use ofCPT-11 or SN-38 when given in any form, (including prodrug and precursorforms that are converted to SN-38 systemically or within the tumour andincluding liposomal formulations), when administered via any route.

Radiotherapy may be administered according to the known practices inclinical radiotherapy. The dosages of ionising radiation will be thoseknown for use in clinical radiotherapy. The radiation therapy used willinclude for example the use of γ-rays, X-rays, and/or the directeddelivery of radiation from radioisotopes. Other forms of DNA damagingfactors are also included in the present invention such as microwavesand UV-irradiation. For example X-rays may be dosed in daily doses of1.8-2.0 Gy, 5 days a week for 5-6 weeks. Normally a total fractionateddose will lie in the range 45-60 Gy. Single larger doses, for example5-10 Gy may be administered as part of a course of radiotherapy. Singledoses may be administered intraoperatively. Hyperfractionatedradiotherapy may be used whereby small doses of X-rays are administeredregularly over a period of time, for example 0.1 Gy per hour over anumber of days. Dosage ranges for radioisotopes vary widely, and dependon the half-life of the isotope, the strength and type of radiationemitted, and on the uptake by cells.

As stated above the size of the dose of each therapy which is requiredfor the therapeutic or prophylactic treatment of a particular diseasestate will necessarily be varied depending on the host treated, theroute of administration and the severity of the illness being treated.Accordingly the optimum dosage may be determined by the practitioner whois treating any particular patient. For example, it may be necessary ordesirable to reduce the above-mentioned doses of the components of thecombination treatments in order to reduce toxicity.

The combination treatments of the present invention comprise: ZD6474 and5-FU; ZD6474 and CPT-11; ZD6474, 5-FU and CPT-11; ZD6474, 5-FU andionising radiation; ZD6474, CPT-11 and ionising radiation; ZD6474, 5-FU,CPT-11 and ionising radiation. The agents therein may be administeredseparately or sequentially in any order, or may be administeredsimultaneously.

The present invention comprises combinations of 5-FU or CPT-11 or 5-FUand CPT-11 with ZD6474 or with a salt of ZD6474.

Salts for use in pharmaceutical compositions will be pharmaceuticallyacceptable salts, but other salts may be useful in the production ofZD6474 and its pharmaceutically acceptable salts. Such salts may beformed with an inorganic or organic base which affords apharmaceutically acceptable cation. Such salts with inorganic or organicbases include for example an alkali metal salt, such as a sodium orpotassium salt, an alkaline earth metal salt such as a calcium ormagnesium salt, an ammonium salt or for example a salt with methylamine,dimethylamine, trimethylamine, piperidine, morpholine ortris-(2-hydroxyethyl)amine.

ZD6474 may be made, for example, according to any of the followingprocesses illustrated by examples (a)-(c) in which, unless otherwisestated:—

(i) evaporations were carried out by rotary evaporation in vacuo andwork-up procedures were carried out after removal of residual solidssuch as drying agents by filtration;

(ii) operations were carried out at ambient temperature, that is in therange 18-25° C. and under an atmosphere of an inert gas such as argon;

(iii) column chromatography (by the flash procedure) and medium pressureliquid chromatography (MPLC) were performed on Merck Kieselgel silica(Art. 9385) or Merck Lichroprep RP-18 (Art. 9303) reversed-phase silicaobtained from E. Merck, Darmstadt, Germany;

(iv) yields are given for illustration only and are not necessarily themaximum attainable;

(v) melting points are uncorrected and were determined using a MettlerSP62 automatic melting point apparatus, an oil-bath apparatus or aKoffler hot plate apparatus.

(vi) the structures of the end-products of the formula I were confirmedby nuclear (generally proton) magnetic resonance (NMR) and mass spectraltechniques; proton magnetic resonance chemical shift values weremeasured on the delta scale and peak multiplicities are shown asfollows: s, singlet; d, doublet; t, triplet; m, multiplet; br, broad; q,quartet; NMR spectra were run on a 400 MHz machine at 24° C.

(vii) intermediates were not generally fully characterised and puritywas assessed by thin layer chromatography (TLC), high-performance liquidchromatography (HPLC), infra-red (IR) or NMR analysis;

(viii) the following abbreviations have been used:—

-   -   DMF N,N-dimethylformamide    -   DMSO dimethylsulphoxide    -   THF tetrahydrofuran    -   TFA trifluoroacetic acid    -   NMP 1-methyl-2-pyrrolidinone.]        Process (a)

A solution of 37% aqueous formaldehyde (50 μl, 0.6 mmol) followed bysodium cyanoborohydride (23 mg, 0.36 mmol) were added to a solution of4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(piperidin-4-ylmethoxy)quinazoline(139 mg, 0.3 mmol), in a mixture of THF/methanol (1.4 ml/1.4 ml). Afterstirring for 1 hour at ambient temperature, water was added and thevolatiles were removed under vacuum. The residue was triturated withwater, filtered, washed with water, and dried under vacuum. The solidwas purified by chromatography on neutral alumina eluting with methylenechloride followed by methylene chloride/ethyl acetate (1/1) followed bymethylene chloride/ethyl acetate/methanol (50/45/5). The fractionscontaining the expected product were evaporated under vacuum Theresulting white solid was dissolved in methylene chloride/methanol (3ml/3 ml) and 3N hydrogen chloride in ether (0.511) was added. Thevolatiles were removed under vacuum. The solid was triturated withether, filtered, washed with ether and dried under vacuum to give4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazolinehydrochloride (120 mg, 69%).

MS-ESI: 475-477 [MH]⁺

The NMR spectrum of the protonated form of4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazolinehydrochloride shows the presence of 2 forms A and B in a ratio A:B ofapproximately 9:1.

¹H NMR Spectrum (DMSOd₆; CF₃COOD) 1.55-1.7 (m, form A 2H); 1.85-2.0 (1,form B 4); 2.03 (d, form A 2H); 2.08-2.14 (br s, form A 1H); 2.31-2.38(br s, form B 1H); 2.79 (s, form A 3H); 2.82 (s, form B 311); 3.03 (t,form A 2H); 3.21 (br s, form B 211); 3.30 (br s, form B 2H); 3.52 (d,form A 2H); 4.02 (s, 3H); 4.12 (d, form A 2H); 4.30 (d, form B 2H); 7.41(s, 1H); 7.5-7.65 (m, 2H); 7.81 (d, 1H); 8.20 (s, 1H); 8.88 (s, 1H)Elemental analysis: Found C 46.0 H 5.2 N 9.6 C₂₂H₂₄N₄O₂BrF0.3H₂O2.65HClRequires C 45.8 H 4.8 N 9.7%

The starting material was prepared as follows:

A solution of 7-benzyloxy-4-chloro-6-methoxyquinazoline hydrochloride(8.35 g, 27.8 mmol), (prepared, for example, as described in WO97/22596, Example 1), and 4-bromo-2-fluoroaniline (5.65 g, 29.7 mmol) in2-propanol (200 ml) was heated at reflux for 4 hours. The resultingprecipitate was collected by filtration, washed with 2-propanol and thenether and dried under vacuum to give7-benzyloxy-4-(4-bromo-2-fluoroanilino)-6-methoxyquinazolinehydrochloride (9.46 g, 78%).

¹H NMR Spectrum: (DMSOd₆; CD₃COOD) 4.0 (s, 3H); 5.37 (s, 2H); 7.35-7.5(m, 4H); 7.52-7.62 (m, 4H); 7.8 (d, 1H); 8.14 (9s, 1H); 8.79 (s, 1H)

MS-ESI: 456 [MH]⁺ Elemental analysis: Found C 54.0 H 3.7 N 8.7C₂₂H₁₇N₃O₂BrF0.9HCl Requires C 54.2 H 3.7 N 8.6%

A solution of7-benzyloxy-4-(4-bromo-2-fluoroanilino)-6-methoxyquinazolinehydrochloride (9.4 g, 19.1 mmol) in TFA (90 ml) was heated at reflux for50 minutes. The mixture was allowed to cool and was poured on to ice.The resulting precipitate was collected by filtration and dissolved inmethanol (70 ml). The solution was adjusted to pH9-10 with concentratedaqueous ammonia solution. The mixture was concentrated to half initialvolume by evaporation. The resulting precipitate was collected byfiltration, washed with water and then ether, and dried under vacuum togive 4-(4-bromo-2-fluoroanilino)-7-hydroxy-6-methoxyquinazoline (5.66 g,82%).

¹H NMR Spectrum (DMSOd₆; CD₃COOD) 3.95 (s, 3H); 7.09 (s, 1H); 7.48 (s,1H); 7.54 (t, 1H); 7.64 (d, 1H); 7.79 (s, 1H); 8.31 (s, 1H)

MS-ESI: 366 [MH]⁺ Elemental analysis: Found C 49.5 H 3.1 N 11.3C₁₅H₁₁N₃O₂BrF Requires C 49.5 H 3.0 N 11.5%

While maintaining the temperature in the range 0-5° C., a solution ofdi-tert-butyl dicarbonate (41.7 g, 0.19 mol) in ethyl acetate (75 ml)was added in portions to a solution of ethyl 4-piperidinecarboxylate (30g, 0.19 mol) in ethyl acetate (150 ml) cooled at 5° C. After stirringfor 48 hours at ambient temperature, the mixture was poured onto water(300 ml). The organic layer was separated, washed successively withwater (200 ml), 0.1N aqueous hydrochloric acid (200 ml), saturatedsodium hydrogen carbonate (200 ml) and brine (200 ml), dried (MgSO₄) andevaporated to give ethyl4-(1-(tert-butoxycarbonyl)piperidine)carboxylate (48 g, 98%).

¹H NMR Spectrum (CDCl₃) 1.25 (t, 3H); 1.45 (s, 9H); 1.55-1.70 (m, 2H);1.8-2.0 (d, 2H); 2.35-2.5 (m, 1H); 2.7-2.95 (t, 2H); 3.9-4.1 (br s, 2H);4.15 (q, 2H)

A solution of 1M lithium aluminium hydride in THF (133 ml, 0.133 mol)was added in portions to a solution of ethyl4-(1-(tert-butoxycarbonyl)piperidine)carboxylate (48 g, 0.19 mol) in dryTHF (180 ml) cooled at 0° C. After stirring at 0° C. for 2 hours, water(30 ml) was added followed by 2N sodium hydroxide (10 ml). Theprecipitate was removed by filtration through diatomaceous earth andwashed with ethyl acetate. The filtrate was washed with water, brine,dried (MgSO₄) and evaporated to give1-(tert-butoxycarbonyl)-4-hydroxymethylpiperidine (36.3 g, 89%).

MS (EI): 215 [M.]+

¹H NMR Spectrum (CDCl₃) 1.05-1.2 (m, 2H); 1.35-1.55 (m, 10H); 1.6-1.8(m, 2H); 2.6-2.8 (t, 2H); 3.4-3.6 (t, 2H); 4.0-4.2 (br s, 2H)

1,4-Diazabicyclo[2.2.2]octane (42.4 g, 0.378 mol) was added to asolution of 1-(tertbutoxycarbonyl)-4-hydroxymethylpiperidine (52.5 g,0.244 mol) in tert-butyl methyl ether (525 ml). After stirring for 15minutes at ambient temperature, the mixture was cooled to 5° C. and asolution of toluene sulphonyl chloride (62.8 g, 0.33 mmol) in tert-butylmethyl ether (525 ml) was added in portions over 2 hours whilemaintaining the temperature at 0° C. After stirring for 1 hour atambient temperature, petroleum ether (11) was added. The precipitate wasremoved by filtration. The filtrate was evaporated to give a solid. Thesolid was dissolved in ether and washed successively with 0.5N aqueoushydrochloric acid (2×500 ml), water, saturated sodium hydrogen carbonateand brine, dried (MgSO₄) and evaporated to give1-(tertbutoxycarbonyl)-4-(4-methylphenylsulphonyloxymethyl)piperidine(76.7 g, 85%).

MS (BSI): 392 [MNa]⁺

¹H NMR Spectrum (CDCl₃) 1.0-1.2 (m, 2H); 1.45 (s, 9H); 1.65 (d, 2H);1.75-1.9 (m, 2H); 2.45 (s, 3H); 2.55-2.75 (m, 2H); 3.85 (d, 1H); 4.0-4.2(br s, 2H); 7.35 (d, 2H); 7.8 (d, 2H)

Potassium carbonate (414 mg, 3 mmol) was added to a suspension of4-(4-bromo-2-fluoroanilino)-7-hydroxy-6-methoxyquinazoline (546 mg, 1.5mmol) in DMF (5 ml). After stirring for 10 minutes at ambienttemperature,1-(tert-butoxycarbonyl)-4-(4-methylphenylsulphonyloxymethyl)piperidine(636 mg, 1.72 mmol) was added and the mixture was heated at 95° C. for 2hours. After cooling, the mixture was poured onto cooled water (20 ml).The precipitate was collected by filtration, washed with water, anddried under vacuum to give4-(4-bromo-2-fluoroanilino)-7-(1-(tert-butoxycarbonyl)piperidin-4-ylmethoxy)-6-methoxyquinazoline(665 mg, 79%).

MS-ESI: 561-563 [MH]⁺

¹H NMR Spectrum (DMSOd₆) 1.15-1.3 (m, 2H), 1.46 (s, 9H), 1.8 (d, 2H),2.0-2.1 (m, 1H), 2.65-2.9 (m, 2H), 3.95 (s, 3H), 4.02 (br s, 2H), 4.05(d, 2H), 7.2 (s, 1H), 7.48 (d, 1H), 7.55 (t, 1H), 7.65 (d, 1H), 7.8 (s,1H), 8.35 (s, 1H), 9.55 (br s, 1H)

TFA (3 ml) was added to a suspension of4-(4-bromo-2-fluoroanilino)-7-(1-(tertbutoxycarbonyl)piperidin-4-ylmethoxy)-6-methoxyquinazoline(673 mg, 1.2 mmol) in methylene chloride (10 ml). After stirring for 1hour at ambient temperature, the volatiles were removed under vacuum.The residue was triturated with a mixture of water/ether. The organiclayer was separated. The aqueous layer was washed again with ether. Theaqueous layer was adjusted to pH10 with 2N aqueous sodium hydroxide. Theaqueous layer was extracted with methylene chloride. The organic layerwas dried (MgSO₄) and the solvent was removed under vacuum The solid wastriturated with a mixture ether/petroleum ether (1/1), filtered, washedwith ether and dried under vacuum to give4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(piperidin-4-ylmethoxy)quinazoline(390 mg, 70.5%).

MS-ESI: 461-463 [MH]⁺

¹H NMR Spectrum (DMSOd₆) 1.13-1.3 (m, 2H), 1.75 (d, 2H), 1.87-2.0 (m,1H), 2.5 (d, 2H), 3.0 (d, 2H), 3.96 (s, 3H), 3.98 (d, 2H), 7.2 (s, 1H),7.5 (dd, 1H), 7.55 (t, 1H), 7.68 (dd, 1H), 7.80 (s, 1H), 8.36 (s, 1H),9.55 (br s, 1H) Elemental analysis: Found C 54.5 H 4.9 N 12.1C₂₁H₂₂N₄O₂BrF Requires C 54.7 H 4.8 N 12.1%Process (b)

37% Aqueous formaldehyde (3.5 ml, 42 mmol) was added to a solution of4-(4-bromo-2-fluoroanilino)-7-(1-(tert-butoxycarbonyl)piperidin-4-ylmethoxy)-6-methoxyquinazoline(3.49 g, 6.22 mmol), (prepared as described for the starting material inprocess (a) above), in formic acid (35 ml). After heating at 95° C. for4 hours the volatiles were removed under vacuum. The residue wassuspended in water and the mixture was adjusted to pH10.5 by slowaddition of a solution of 2N sodium hydroxide. The suspension wasextracted with ethyl acetate. The organic layer was washed with brine,dried MgSO₄ and evaporated to give4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazoline(2.61 g, 88%).

MS-ESI: 475-477 [MH]⁺

¹H NMR Spectrum (DMSOd₆) 1.3-1.45 (n, 2H), 1.8 (d, 2H), 1.7-1.9 (m, 1H),1.95 (t, 2H), 2.2 (s, 3H), 2.85 (d, 2H), 3.96 (s, 3H), 4.05 (d, 2H),7.19 (s, 1H), 7.5 (d, 1H), 7.55 (t, 1H), 7.67 (d, 1H), 7.81 (s, 1H),8.37 (s, 1H), 9.54 (s, 1H) Elemental analysis: Found C 55.4 H 5.1 N 11.6C₂₂H₂₄N₄O₂BrF Requires C 55.6 H 5.1 N 11.8%

Process (c) A suspension of4-chloro-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazoline (200 mg,0.62 mmol) and 4-bromo-2-fluoroaniline (142 mg, 0.74 mol) in isopropanol(3 ml) containing 6N hydrogen chloride in isopropanol (110 μl, 0.68 ml)was heated at reflux for 1.5 hours. After cooling, the precipitate wascollected by filtration, washed with isopropanol followed by ether anddried under vacuum to give4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazolinehydrochloride (304 mg, 90%). Elemental analysis: Found C 47.9 H 4.9 N10.0 C₂₂H₂₄N₄O₂BrF0.5H₂O1.8HCl Requires C 48.2 H 5.0 N 10.1% 0.08isopropanol

The NMR spectrum of the protonated form of4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazolinehydrochloride shows the presence of two forms A and B in a ratio A:B ofapproximately 9:1.

¹H NMR Spectrum (DMSOd₆) 1.6-1.78 (m, form A 2H); 1.81-1.93 (br s, formB 4H); 1.94-2.07 (d, form A 2H); 2.08-2.23 (br s, form A 1H); 2.29-2.37(br s, form B 1H); 2.73 (d, form A 3H); 2.77 (d, form B 311); 2.93-3.10(q, form A 2H); 3.21 (br s, form B 2H); 3.27 (br s, form B 2H);3.42-3.48 (d, form A 2H); 4.04 (s, 3H); 4.10 (d, form A 2H); 4.29 (d,form B 2H); 7.49 (s, 1H); 7.53-7.61 (m, 2H); 7.78 (d, 1H); 8.47 (s, 1H);8.81 (s, 1H); 10.48 (br s, form A 1H); 10.79 (br s, form B 11); 11.90(br s, 1H)

For another NMR reading, some solid potassium carbonate was added intothe DMSO solution of the4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazolinehydrochloride described above, in order to release the free base in theNMR tube. The NMR spectrum was then recorded again and showed only oneform as described below:

¹H NMR Spectrum (DMSOd₆; solid potassium carbonate) 1.3-1.45 (m, 2H);1.75 (d, 2H); 1.7-1.9 (m, 1H); 1.89 (t, 2H); 2.18 (s, 3H); 2.8 (d, 2H);3.98 (s, 3H); 4.0 (d, 2H); 7.2 (s, 1H); 7.48 (d, 1H); 7.55 (t, 1H); 7.68(d, 1H); 7.8 (s, 1H); 8.35 (s, 1H); 9.75 (s, 1H)

A sample of4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazoline(free base) was generated from the4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazolinehydrochloride, (prepared as described above), as follows:

4-(4-Bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxyquinazolinehydrochloride (50 mg) was suspended in methylene chloride (2 ml) and waswashed with saturated sodium hydrogen carbonate. The methylene chloridesolution was dried (MgSO₄) and the volatiles were removed by evaporationto give4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazoline(free base). The NMR of the free base so generated shows only one formas described below:

¹H NMR Spectrum: (DMSOd₆) 1.3-1.45 (m, 2H); 1.76 (d, 2H); 1.7-1.9 (m,1H); 1.9 (t, 2H); 2.19 (s, 3H); 2.8 (d, 2H); 3.95 (s, 3H); 4.02 (d, 2H);7.2 (s, 1H); 7.48 (d, 1H); 7.55 (t, 1H) ; 7.68 (dd, 1H); 7.8 (s, 1);8.38 (s, 1H); 9.55 (br s, 1H)

For another NMR reading, some CF₃COOD was added into the NMR DMSOsolution of the4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazoline(free base) descried above and the NMR spectrum was recorded again. Thespectrum of the protonated form of the4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazolinetrifluoroacetate salt so obtained shows the presence of two forms A andB in a ratio A:B of approximately 9:1.

¹H NMR Spectrum (DMSOd₆; CF₃COOD) 1.5-1.7 (m, form A 21); 1.93 (br s,form B 4H); 2.0-2.1 (d, form A 2H); 2.17 (br s, form A 1H); 2.35 (br s,form B 1H); 2.71 (s, form A 3H); 2.73 (s, form B 3H); 2.97-3.09 (t, formA 2H); 3.23 (br s, form B 2H); 3.34 (br s, form B 211); 3.47-3.57 (d,form A 2H); 4.02 (s, 3H); 4.15 (d, form A 2H); 4.30 (d, form B 2H); 7.2(s, 1H); 7.3-7.5 (m, 2H); 7.6 (d, 1H); 7.9 (s, 1H); 8.7 (s, 1H)

The starting material was prepared as follows:

1-(tert-Butoxycarbonyl)-4-(4-methylphenylsulphonyloxymethyl)piperidine(40 g, 0.11 mol), (prepared as described for the starting material inprocess (a) above), was added to a suspension of ethyl4-hydroxy-3-methoxybenzoate (19.6 g, 0.1 mol) and potassium carbonate(28 g, 0.2 mol) in dry DMF (200 ml). After stirring at 95° C. for 2.5hours, the mixture was cooled to ambient temperature and partitionedbetween water and ethyl acetate/ether. The organic layer was washed withwater, brine, dried (MgSO₄) and evaporated. The resulting oil wascrystallised from petroleum ether and the suspension was storedovernight at 5° C. The solid was collected by filtration, washed withpetroleum ether and dried under vacuum to give ethyl4-(1-(tert-butoxycarbonyl)piperidin-4-ylmethoxy)-3-methoxybenzoate (35g, 89%).

m.p. 81-83° C.

MS (ESI): 416 [MNa]⁺

¹H NMR Spectrum (CDCl₃) 1.2-1.35 (m, 2H); 1.4 (t, 3H); 1.48 (s, 9H);1.8-1.9 (d, 2H); 2.0-2.15 (m, 2H); 2.75 (t, 2H); 3.9 (d, 2H); 3.95 (s,3H); 4.05-4.25 (br s, 2H); 4.35 (q, 2H); 6.85 (d, 1H); 7.55 (s, 1H);7.65 (d, 1H) Elemental analysis: Found C 63.4 H 8.0 N 3.5C₂₁H₃₁NO₆0.3H₂O Requires C 63.2 H 8.0 N 3.5%

Formaldehyde (12M, 37% in water, 35 ml, 420 mmol) was added to asolution of ethyl4-(1-(tert-butoxycarbonyl)piperidin-4-ylmethoxy)-3-methoxybenzoate (35g, 89 mmol) in formic acid (35 ml). After stirring at 95° C. for 3hours, the volatiles were removed by evaporation. The residue wasdissolved in methylene chloride and 3M hydrogen chloride in ether (40ml, 120 mmol) was added. After dilution with ether, the mixture wastriturated until a solid was formed. The solid was collected byfiltration, washed with ether and dried under vacuum overnight at 50° C.to give ethyl 3-methoxy-4-(1-methylpiperidin-4-ylmethoxy)benzoate (30.6g, quant.).

MS (ESI): 308 [MH]⁺

¹H NMR Spectrum (DMSOd₆) 1.29 (t, 3H); 1.5-1.7 (m, 2H); 1.95 (d, 21);2.0-2.15 (br s, 1H); 2.72 (s, 3H); 2.9-3.1 (m, 2H); 3.35-3.5 (br s, 2H);3.85 (s, 3H); 3.9-4.05 (br s, 2H); 4.3 (q, 2H); 7.1 (d, 1H); 7.48 (s,1H); 7.6 (d, 1H)

A solution of ethyl 3-methoxy-4-(1-methylpiperidin-4-ylmethoxy)benzoate(30.6 g, 89 mmol) in methylene chloride (75 ml) was cooled to 0-5° C.TFA (37.5 ml) was added followed by the dropwise addition over 15minutes of a solution of fuming 24N nitric acid (7.42 ml, 178 mmol) inmethylene chloride (15 ml). After completion of the addition, thesolution was allowed to warm up and stirred at ambient temperature for 2hours. The volatiles were removed under vacuum and the residue wasdissolved in methylene chloride (50 ml). The solution was cooled to 0-5°C. and ether was added. The precipitate was collected by filtration, anddried under vacuum at 50° C. The solid was dissolved in methylenechloride (500 ml) and 3M hydrogen chloride in ether (30 ml) was addedfollowed by ether (500 ml). The solid was collected by filtration anddried under vacuum at 50° C. to give ethyl3-methoxy-4-(1-methylpiperidin-4-ylmethoxy)-6-nitrobenzoate (28.4 g,82%).

MS (ESI): 353 [MH]⁺

¹H NMR Spectrum: (DMSOd₆) 1.3 (t, 3H); 1.45-1.65 (m, 2H); 1.75-2.1 (m,3H); 2.75 (s, 3H); 2.9-3.05 (m, 2H); 3.4-3.5 (d, 2H); 3.95 (s, 3H); 4.05(d, 2H); 4.3 (q, 2H); 7.32 (s, 1H); 7.66 (s, 1H)

A suspension of ethyl3-methoxy-4-(1-methylpiperidin-4-ylmethoxy)-6-nitrobenzoate (3.89 g, 10mmol) in methanol (80 ml) containing 10% platinum on activated carbon(50% wet) (389 mg) was hydrogenated at 1.8 atmospheres pressure untiluptake of hydrogen ceased. The mixture was filtered and the filtrate wasevaporated. The residue was dissolved in water (30 ml) and adjusted topH10 with a saturated solution of sodium hydrogen carbonate. The mixturewas diluted with ethyl acetate/ether (1/1) and the organic layer wasseparated. The aqueous layer was further extracted with ethylacetate/ether and the organic layers were combined. The organic layerswere washed with water, brine, dried (MgSO₄), filtered and evaporated.The resulting solid was triturated in a mixture of ether/petroleumether, filtered, washed with petroleum ether and dried under vacuum at60° C. to give ethyl6-amino-3-methoxy-4-(1-methylpiperidin-4-ylmethoxy)benzoate (2.58 g,80%).

m.p. 111-112° C.

MS (ESI): 323 [MH]⁺

¹H NMR Spectrum (CDCl₃) 1.35 (t, 3H); 1.4-1.5 (m, 2H); 1.85 (m, 3H);1.95 (t, 2H); 2.29 (s, 3H); 2.9 (d, 2H); 3.8 (s, 3H); 3.85 (d, 21); 4.3(q, 2H); 5.55 (br s, 2H); 6.13 (s, 1H); 7.33 (s, 1H) Elemental analysis:Found C 62.8 H 8.5 N 8.3 C₁₇H₂₆N₂O₄0.2H₂O Requires C 62.6 H 8.2 N 8.6%

A solution of ethyl6-amino-3-methoxy-4-(1-methylpiperidin-4-ylmethoxy)benzoate (16.1 g, 50mmol) in 2-methoxyethanol (160 ml) containing formamidine acetate (5.2g, 50 mmol) was heated at 115° C. for 2 hours. Formamidine acetate (10.4g, 100 mmol) was added in portions every 30 minutes over 4 hours.Heating was prolonged for 30 minutes after the last addition. Aftercooling, the volatiles were removed under vacuum The solid was dissolvedin ethanol (100 ml) and methylene chloride (50 ml). The precipitate wasremoved by filtration and the filtrate was concentrated to a finalvolume of 100 ml. The suspension was cooled to 5° C. and the solid wascollected by filtration, washed with cold ethanol followed by ether anddried under vacuum overnight at 60° C. to give6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)-3,4-dihydroquinazolin-4-one(12.7 g, 70%).

MS (ESI): 304 [MH]⁺

¹H NMR Spectrum (DMSOd₆) 1.25-1.4 (m, 2H); 1.75 (d, 2H); 1.9 (t, 1H);1.9 (s, 3H); 2.16 (s, 2H); 2.8 (d, 2H); 3.9 (s, 3H); 4.0 (d, 2H); 7.11(s, 1H); 7.44 (s, 1H); 7.97 (s, 1H)

A solution of6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)-3,4-dihydroquinazolin-4-one(2.8 g, 9.24 mmol) in thionyl chloride (28 ml) containing DMF (280 μl)was heated at reflux at 85° C. for 1 hour. After cooling, the volatileswere removed by evaporation. The precipitate was triturated with ether,filtered, washed with ether and dried under vacuum. The solid wasdissolved in methylene chloride and saturated aqueous sodium hydrogencarbonate was added. The organic layer was separated, washed with water,brine, dried (MgSO₄) and evaporated to give4-chloro-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazoline (2.9 g,98%).

MS (ESI): 322 [MH]⁺

¹H NMR Spectrum: (DMSOd₄) 1.3-1.5 (m, 2H); 1.75-1.9 (m, 3H); 2.0 (t,1H); 2.25 (s, 3H); 2.85 (d, 2H); 4.02 (s, 3H); 4.12 (d, 2H); 7.41 (s,1H); 7.46 (s, 1H); 8.9 (s, 1H)

Alternatively, the6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)-3,4-dihydroquinazolin-4-onecan be prepared as follows:

Sodium hydride (1.44 g of a 60% suspension in mineral oil, 36 mmol) wasadded in portions over 20 minutes to a solution of7-benzyloxy-6-methoxy-3,4-dihydroquinazolin-4-one (8.46 g, 30 mmol),(prepared, for example, as described in WO 97/22596, Example 1), in DMF(70 ml) and the mixture was stirred for 1.5 hours. Chloromethyl pivalate(5.65 g, 37.5 mmol) was added in portions and the mixture stirred for 2hours at ambient temperature. The mixture was diluted with ethyl acetate(100 ml) and poured onto ice/water (400 ml) and 2N hydrochloric acid (4ml). The organic layer was separated and the aqueous layer extractedwith ethyl acetate, the combined extracts were washed with brine, dried(MgSO₄) and the solvent removed by evaporation. The residue wastriturated with a mixture of ether and petroleum ether, the solid wascollected by filtration and dried under vacuum to give7-benzyloxy-6-methoxy-3-((pivaloyloxy)methyl)-3,4-dihydroquinazolin-4-one(10 g, 84%).

¹H NMR Spectrum (DMSOd₆) 1.11 (s, 9H); 3.89 (s, 3H); 5.3 (s, 2H); 5.9(s, 21); 7.27 (s, 1H); 7.35 (m, 1H); 7.47 (t, 2H); 7.49 (d, 2H); 7.51(s, 1H); 8.34 (s, 1H)

A mixture of7-benzyloxy-6-methoxy-3-((pivaloyloxy)methyl)-3,4-dihydroquinazolin-4-one(7 g, 17.7 mmol) and 10% palladium-on-charcoal catalyst (700 mg) inethyl acetate (250 ml), DMF (50 ml), methanol (50 ml) and acetic acid(0.7 ml) was stirred under hydrogen at atmospheric pressure for 40minutes. The catalyst was removed by filtration and the solvent removedfrom the filtrate by evaporation. The residue was triturated with ether,collected by filtration and dried under vacuum to give7-hydroxy-6-methoxy-3-((pivaloyloxy)methyl)-3,4-dihydroquinazolin-4-one(4.36 g, 80%).

¹H NMR Spectrum: (DMSOd₆) 1.1 (s, 9H); 3.89 (s, 3H); 5.89 (s, 2H); 7.0(s, 1H); 7.48 (s, 1H); 8.5 (s, 1H)

Triphenylphosphine (1.7 g, 6.5 mmol) was added under nitrogen to asuspension of7-hydroxy-6-methoxy-3-((pivaloyloxy)methyl)-3,4-dihydroquinazolin-4-one(1.53 g, 5 mmol) in methylene chloride (20 ml), followed by the additionof 1-(tert-butoxycarbonyl)-4-(hydroxymethyl)piperidine (1.29 g, 6 mmol),(prepared as described for the starting material in process (a) above),and by a solution of diethyl azodicarboxylate (1.13 g, 6.5 mmol) inmethylene chloride (5 ml). After stirring for 30 minutes at ambienttemperature, the reaction mixture was poured onto a column of silica andwas eluted with ethyl acetate/petroleum ether (1/1 followed by 6/5, 6/4and 7/3). Evaporation of the fractions containing the expected productled to an oil that crystallised following trituration with pentane. Thesolid was collected by filtration and dried under vacuum to give7-(1-(tert-butoxycarbonyl)piperidin-4-ylmethoxy)-6-methoxy-3-((pivaloyloxy)methyl)-3,4-dihydroquinazolin-4-one(232 g, 92%).

MS-ESI: 526 [MNa]⁺

¹H NMR Spectrum (CDCl₃) 1.20 (s, 9H), 1.2-1.35 (m, 2H), 1.43 (s, 9H),1.87 (d, 2H), 2.05-2.2 (m 1H), 2.75 (t, 2H), 3.96 (d, 2H), 3.97 (s, 3H),4.1-4.25 (br s, 2H), 5.95 (s, 2H), 7.07 (s, 1H), 7.63 (s, 1H), 8.17 (s,1H) Elemental analysis: Found C 61.8 H 7.5 N 8.3 C₂₆H₃₇N₃O₇ Requires C62.0 H 7.4 N 8.3%

A solution of7-(1-(tert-butoxycarbonyl)piperidin-4-ylmethoxy)-6-methoxy-3-((pivaloyloxy)methyl)-3,4-dihydroquinazolin-4-one(2.32 g, 4.6 mmol) in methylene chloride (23 ml) containing TFA (5 ml)was stirred at ambient temperature for 1 hour. The volatiles wereremoved under vacuum. The residue was partitioned between ethyl acetateand sodium hydrogen carbonate. The organic solvent was removed undervacuum and the residue was filtered. The precipitate was washed withwater, and dried under vacuum. The solid was azeotroped with toluene anddried under vacuum to give6-methoxy-7-(piperidin-4-ylmethoxy)-3-((pivaloyloxy)methyl)-3,4-dihydroquinazolin-4-one(1.7 g, 92%).

MS-ESI: 404 [MH]⁺

¹H NMR Spectrum: (DMSOd₆; CF₃COOD) 1.15 (s, 9H), 1.45-1.6 (m, 2H), 1.95(d, 2H), 2.1-2.25 (m, 1H), 2.95 (t, 2H), 3.35 (d, 2H), 3.95 (s, 3H), 4.1(d, 2H), 5.95 (s, 2h), 7.23 (s, 1H), 7.54 (s, 1H), 8.45 (s, 1H)

A 37% aqueous solution of formaldehyde (501 μl, 6 mmol) followed bysodium cyanoborohydride (228 mg, 3.6 mmol) were added in portions to asolution of6-methoxy-7-(piperidin-4-ylmethoxy)-3-((pivaloyloxy)methyl)-3,4-dihydroquinazolin-4-one(1.21 g, 3 mmol) in a mixture of THF/methanol (10 ml/10 ml). Afterstirring for 30 minutes at ambient temperature, the organic solventswere removed under vacuum and the residue was partitioned betweenmethylene chloride and water. The organic layer was separated, washedwith water and brine, dried (MgSO₄) and the volatiles were removed byevaporation The residue was triturated with ether and the resultingsolid was collected by filtration, washed with ether and dried undervacuum to give6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)-3-((pivaloyloxy)methyl)-3,4-dihydroquinazolin-4-one(1.02 g, 82%).

MS-ESI: 418 [MH]⁺

¹H NMR Spectrum (CDCl₃) 1.19 (s, 9H), 1.4-1.55 (m, 2H), 1.9 (d, 2H), 2.0(t, 2H), 1.85-2.1 (m, 1H), 2.3 (s, 3H), 2.92 (d, 2H), 3.96 (s, 3H), 3.99(d, 2H), 5.94 (s, 2H), 7.08 (s, 1H), 7.63 (s, 1H), 8.17 (s, 1H)

A saturated solution of ammonia in methanol (14 ml) was added to asolution of6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)-3-((pivaloyloxy)methyl)-3,4-dihydroquinazolin-4-one(1.38 g, 3.3 mmol) in methanol (5 ml). After stirring for 20 hours atambient temperature, the suspension was diluted with methylene chloride(10 ml). The solution was filtered. The filtrate was evaporated undervacuum and the residue was triturated with ether, collected byfiltration, washed with ether and dried under vacuum to give6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)-3,4-dihydroquinazolin-4-one(910 mg, 83%).

MS-ESI: 304 [MH]⁺

¹H NMR Spectrum: (DMSOd₆) 1.3-1.45 (m, 2H), 1.75 (d, 2H), 1.7-1.85 (m,1H), 1.9 (t, 2H), 2.2 (s, 3H), 2.8 (d, 2H), 3.9 (s, 3H), 4.0 (d, 21),7.13 (s, 1H), 7.45 (s, 1H), 7.99 (s, 1H)

The following tests were used to demonstrate the activity of ZD6474 incombination with 5-FU and CPT-11.

Human LS-174T Colon Tumour Xenografts in Nude Mice

10⁷ LS-174T tumour cells in 0.2 ml of serum free Roswell Park MemorialInstitute (RPMI)-1640 medium were injected subcutaneously (s.c.) intothe flanks of 10 athymic (nu/nu genotype) mice. When tumour sizesreached 700-1000 mm³ (3-4 weeks), tumours were surgically excised andsmaller tumour fragments thereof (20-30 mg) were implanted s.c. in theright flank of 120 Nude mice. When tumours reached a volume of 100 to200 mm³ (14-16 days after the graft), mice were randomized into groups(13-15 per group) and treatment started.

(a) 5-FU+ZD6474

-   -   The control group (Group 1) received a daily oral (p.o.)        administration of ZD6474 vehicle for 14 consecutive days (day        0-13) combined with two intravenous (i.v.) injections of saline        (the vehicle for 5-FU) on day 0 and 7.    -   For Group 2, the treatments consisted of a daily p.o.        administration of ZD6474 alone at 25 mg/kg/adminstration for 14        consecutive days (day 0-13) combined with two i.v. injections of        saline (the vehicle for 5-FU) on day 0 and 7. ZD6474 was        prepared as a suspension in 1% polysorbate 80 (i.e. a 1% (v/v)        solution of polyoxyethylene (20) sorbitan mono-oleate in        deionised water).    -   Group 3 received two i.v. injections of 5-FU at 75        mg/kg/injection, on day 0 and 7, combined with a daily p.o.        administration of ZD6474 vehicle for 14 consecutive days (day        0-13).    -   Group 4 received daily p.o. administration of ZD6474 at 25        mg/kg/adminstration for 14 consecutive days (day 0-13) combined        with two i.v. injections of 5-FU at 75 mg/kg/injection, on day 0        and 7.

The administration volume of ZD6474 was 10.0 ml/kg (200 μl for a 20 gmouse). The injection volume of 5-FU was 10.0 ml/kg (200 μl for a 20 gmouse). Days- Combined interval drug doses No. between (mg No.Treatment/ treatment Group Treatments base/kg/inj.) Adm. routeTreatments day (Days) 1 Vehicles of  0.0 p.o. for ZD6474 14 p.o. 1 p.o.1 for p.o. ZD6474 vehicle  2 i.v. 1 i.v. 7 for i.v. and 5-FU i.v. forsaline 2 ZD6474 + saline 25.0 p.o. for ZD6474 14 p.o. 1 p.o. 1 for p.o.i.v. for saline  2 i.v. 1 i.v. 7 for i.v. 3 5-FU + ZD6474 75.0 i.v. for5-FU 14 p.o. 1 p.o. 1 for p.o. vehicle p.o. for ZD6474  2 i.v. 1 i.v. 7for i.v. vehicle 4 ZD6474 + 5-FU 25.0 for p.o. for ZD6474 14 p.o. 1 p.o.1 for p.o. ZD6474 i.v. for 5-FU  2 i.v. 1 i.v. 7 for i.v. 75.0 for 5-FU

Tumor volumes (mm³) were assessed at least twice weekly by bilateralVernier caliper measurement and, taking length to be the longestdiameter across the tumor and width the corresponding perpendicular,calculated using the formula (π/6)×(length×width)×the square root of(length×width). Growth inhibition from the start of treatment wasassessed by comparison of the differences in tumor volume betweencontrol and treated groups. For all mice, the study was stopped whentumours reached 2,000 mm³. For all mice, the tumours were excised andweights recorded upon termination of the study.

Inhibition of Control Tumour P value (one-tailed Treatment Growth at day13 two-sample t-test) Regressions* ZD6474 80% 0.01 5/15 (25 mg/kg/dayp.o., d 0-13) 5-FU 68% 0.03 6/15 (75 mg/kg i.v., d 0 and 7) ZD6474 +5-FU 107%  0.002 8/13 (Regression)*Number of tumours which had regressed by ≧10% in volume by day 13, whencompared with their pre-treatment volume on day 0.

The combination of 5-FU with ZD6474 produced a significantly greaterinhibition of tumour growth than 5-FU alone (P=0.018 at day 13, byone-tailed two-sample t test).

The combination of 5-FU with ZD6474 produced a significantly greaterinhibition of tumour growth than ZD6474 alone, (P=0.027 at day 13, byone-tailed two-sample t test).

The combination of 5-FU with ZD6474 produced more tumour regressions(62%) than ZD6474 alone (33%) or 5-FU alone (40%).

(b) CPT-11+ZD6474

-   -   The control group (Group 1) received a daily oral (p.o.)        administration of ZD6474 vehicle for 14 consecutive days (day        0-13) combined with two intravenous (i.v.) injections of saline        (the vehicle for CPT-11) on day 0 and 7. The control group was        not continued past this period, as some of the tumour volumes        were considered too large (˜2 cm³).    -   For Group 2, the treatments consisted of a daily p.o.        administration of ZD6474 alone at 25 mg/kg/adminstration for 21        consecutive days (day 0-20) combined with three i.v. injections        of saline (the vehicle for CPT-1) on day 0, 7 and 14. ZD6474 was        prepared as a suspension in 1% polysorbate 80 (i.e. a 1% (v/v)        solution of polyoxyethylene (20) sorbitan mono-oleate in        deionised water).    -   Group 3 received three i.v. injections of CPT-11 at 20        mg/kg/injection, on day 0, 7 and 14, combined with a daily p.o.        administration of ZD6474 vehicle for 21 consecutive days (day        0-20).    -   Group 4 received daily p.o. administration of ZD6474 at 25        mg/kg/adminstration for 21 consecutive days (day 0-20) combined        with three i.v. injections of 5-FU at 20 mg/kg/injection, on day        0, 7 and 14.

The administration volume of ZD6474 was 10.0 ml/kg (200 μl for a 20 gmouse). The injection volume of CPT-11 was 10.0 ml/kg (200 μl for a 20 gmouse). Days- Combined drug interval doses No. between (mg No.Treatment/ treatment Group Treatments base/kg/inj.) Adm. routeTreatments day (Days) 1 Vehicles of  0.0 p.o. for 14 p.o. 1 p.o. 1 forp.o. ZD6474 ZD6474  2 i.v. 1 i.v. 7 for i.v. and CPT-11 vehicle i.v. forsaline 2 ZD6474 + saline 25.0 p.o. for 21 p.o. 1 p.o. 1 for p.o. ZD6474 3 i.v. 1 i.v. 7 for i.v. i.v. for saline 3 CPT-11 + ZD6474 20.0 i.v.for CPT-11 21 p.o. 1 p.o. 1 for p.o. vehicle p.o. for  3 i.v. 1 i.v. 7for i.v. ZD6474 vehicle 4 ZD6474 + CPT-11 25.0 for ZD6474 p.o. for 21p.o. 1 p.o. 1 for p.o. 20.0 for CPT-11 ZD6474  3 i.v. 1 i.v. 7 for i.v.i.v. for CPT-11

Tumor volumes (mm³) were assessed at least twice weekly by bilateralVernier caliper measurement and, taking length to be the longestdiameter across the tumor and width the corresponding perpendicular,calculated using the formula (π/6)×(length×width)×square root of(length×width). Growth inhibition from the start of treatment wasassessed by comparison of the differences in tumor volume betweencontrol and treated groups. For all mice, the study was stopped whentumours reached 2,000 mm³. For all mice, the tumours were excised andweights recorded upon termination of the study.

The mean tumour volumes on day 20 for mice treated with ZD6474 (25mg/kg/day p.o., d 0-20), CPT-11 (20 mg/kg i.v., d 0, 7 and 14), or thecombination thereof, were 475 mm³, 552 mm³ and 336 mm³ respectively.

An analogous experiment may be used to look at the combination ofZD6474, 5-FU and CPT-11 in this animal model.

An analogous experiment may be used to look at the combination ofZD6474, 5-FU, CPT-11 and ionising radiation in this animal model.

1. Use of4-(4-bromo-2-fluoroanilino)-6-methoxy-7-(1-methylpiperidin-4-ylmethoxy)quinazoline,also known as ZD6474:

or a pharmaceutically acceptable salt thereof and one of: a) 5-FU; b)CPT-11; and c) 5-FU and CPT-11 in the manufacture of a medicament foruse in the production of an antiangiogenic and/or vascular permeabilityreducing effect in a warm-blooded animal such as a human.
 2. Use ofZD6474 or a pharmaceutically acceptable salt thereof and one of: a)5-FU; b) CPT-11; and c) 5-FU and CPT-11 in the manufacture of amedicament for use in the production of an anti-cancer effect in awarm-blooded animal such as a human.
 3. Use of ZD6474 or apharmaceutically acceptable salt thereof and one of: a) 5-FU; b) CPT-11;and c) 5-FU and CPT-11 in the manufacture of a medicament for use in theproduction of an anti-tumour effect in a warm-blooded animal such as ahuman.
 4. Use of ZD6474 or a pharmaceutically acceptable salt thereofand 5-FU in the manufacture of a medicament for use in the production ofan anti-cancer effect in a warm-blooded animal such as a human which isbeing treated with ionising radiation.
 5. Use of ZD6474 or apharmaceutically acceptable salt thereof and CPT-11 in the manufactureof a medicament for use in the production of an anti-cancer effect in awarm-blooded animal such as a human which is being treated with ionisingradiation.
 6. Use of ZD6474 or a pharmaceutically acceptable saltthereof and 5-FU and CPT-11 in the manufacture of a medicament for usein the production of an anti-cancer effect in a warm-blooded animal suchas a human which is being treated with ionising radiation.
 7. Useaccording to any one of claims 2, 4, 5 and 6 wherein the cancer iscolorectal cancer.
 8. A pharmaceutical composition comprising ZD6474 ora pharmaceutically acceptable salt thereof, and 5-FU in association witha pharmaceutically acceptable excipient or carrier.
 9. A pharmaceuticalcomposition comprising ZD6474 or a pharmaceutically acceptable saltthereof, and CPT-11 in association with a pharmaceutically acceptableexcipient or carrier.
 10. A pharmaceutical composition comprising ZD6474or a pharmaceutically acceptable salt thereof, and 5-FU and CPT-11 inassociation with a pharmaceutically acceptable excipient or carrier. 11.A kit comprising ZD6474 or a pharmaceutically acceptable salt thereof,and 5-FU.
 12. A kit comprising ZD6474 or a pharmaceutically acceptablesalt thereof, and CPT-11.
 13. A kit comprising ZD6474 or apharmaceutically acceptable salt thereof, and 5-FU and CPT-11.
 14. Amethod for the treatment of a cancer in a warm-blooded animal such as ahuman, which comprises administering to said animal an effective amountof ZD6474 or a pharmaceutically acceptable salt thereof, before, afteror simultaneously with an effective amount of one of: a) 5-FU; b)CPT-11; and c) 5-FU and CPT-11.